Author’s replyBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d2731 (Published 03 May 2011) Cite this as: BMJ 2011;342:d2731
- Des Spence, general practitioner1
Sports medicine encompasses sports science, performance medicine, physiotherapy, podiatry, and sports surgery. I searched for the best systematic evidence, which encompassed 11 references, six of them Cochrane Reviews.
Massage and ultrasound may give some symptomatic pain relief, but this is not the same as effecting healing. Bartley offers some evidence that ultrasound works in vitro,1 but does a plausible physiological and biochemical explanation exist that can be applied in vivo? Baker et al conclude: “There is currently insufficient biophysical evidence to provide a scientific foundation for the clinical use of therapeutic ultrasound for the treatment of people with pain and soft tissue injury.”1
I referenced the most recent systematic review on rotator cuff surgery, which included 14 studies suggesting that conservative treatment may be as effective as surgery.2 Wallace’s new reference is a small randomised controlled trial of 103 patients but is unblinded.3 The evidence of benefit is based on a composite score. Whether the difference in scores is relevant clinically is hard to know: self reporting of pain is fraught, being especially sensitive to a placebo effect.
Wallace is misleading in implying that the debate on anterior cruciate ligament (ACL) reconstruction is resolved and that the surgical technique is the only outstanding issue.3 The Cochrane systematic review is the strongest evidence available and concludes: “There is insufficient evidence from randomised trials to determine whether surgery or conservative management was best for ACL injury in the 1980s, and no evidence to inform current practice.”3 Fithian et al did a small non-randomised study of surgery with a follow-up of 73% for an average of 6.6 years.3 More recent evidence suggests that non-surgical intervention for ACL injury is just as effective at 10 years, even for high level athletes.4 Life is long: does ACL surgery increase the risk of arthritis and knee replacement in the future? It would be good to know.
Cite this as: BMJ 2011;342:d2731
Competing interests: None declared.